What is rectal bleeding?

Rectal bleeding is bleeding from your anus (back passage or bottom). You may see it when you go to the toilet and pass faeces (poo). There may be blood in the toilet or on the toilet paper. You may not notice anything if the bleeding is very slow.

The colour of the blood or faeces (poo) can be a sign of where the bleeding is coming from:

• Bright red blood — this may mean the bleeding is coming from lower in your bowel and closer to your anus (back passage). This may be a sign of haemorrhoids or anal fissures.
• Dark red blood — this may mean bleeding is coming from your colon (large intestine). The blood may be seen mixed in with your faeces. One cause of this bleeding can be polyps. These are growths on the wall of your intestines. Polyps are often harmless. Some types of polyps can turn into bowel cancer.
• Faeces (poo) that is black like tar with a very bad smell — this may mean there is bleeding higher up in your digestive system. The problem could be in your stomach or duodenum (the first part of your small intestine). There are several possible reasons for black faeces, for example, a bleeding peptic ulcer (stomach or duodenal ulcer).

What causes rectal bleeding?

There are lots of causes of rectal bleeding. Common causes of rectal bleeding are:

• hard stools (poo)
• haemorrhoids (also known as piles) — this can happen because of constipation
• anal fissure — a small tear in the skin around the opening of the anus

Less common causes of rectal bleeding are:

• colon polyps
• a stomach or duodenal ulcer
• bowel infections
• gastroenteritis ('gastro')
• bowel conditions — such as diverticular disease or bowel cancer, Crohn's disease or ulcerative colitis
• sexually transmitted infections (STIs)
• rectal trauma — for example, an injury caused by accident or sexual assault

Deliberate harm or injury

Rectal bleeding can happen from an injury done on purpose or accidentally because of trauma (injury), including from inserting items into or out of the anus.

If you think this is the cause of your rectal bleeding, seek help as soon as possible. You could talk to a nurse or doctor at a Medicare Urgent Care Clinic, or go to a hospital emergency department.

When should I see my doctor?

Make an appointment to see your doctor if you have rectal bleeding. Bleeding from the anus could be a sign of a serious health condition.

Most people who have rectal bleeding don't have cancer or another serious illness, but it is important to have rectal bleeding checked by a health professional.

When should I seek urgent care?

Seek urgent medical attention if:

• the bleeding is very heavy
• you have signs of shock — this can be rapid, shallow breathing or dizziness, nausea or confusion
• you have black or dark red poo
• your vomit has blood in it
• your vomit looks like coffee grounds
• you faint
• you have severe pain in your rectum

You should also go to the hospital emergency department if you have heavy bleeding from your anus and:

• severe abdominal (stomach) pain
• fever
• nausea (feeling sick in your stomach)
• you are unable to do a bowel motion (poo)

How is rectal bleeding investigated?

Your doctor will talk to you and examine you. The tests for rectal bleeding depend on your age, symptoms and medical history.

Investigations can include blood tests as well as imaging such as x-ray or CT (computed tomography) scans.

The doctor might want to look inside your rectum and bowel. You might also need tests, including:

• anoscopy — this is when a small instrument is put into your anus. It can let your doctor have a better view.
• sigmoidoscopy — this is a procedure to look inside the lower part of your colon (large bowel). It uses a flexible telescope.
• colonoscopy — a flexible tube is put into the anus. It lets the doctor see the inside of the large bowel (the colon).

Some of these tests are done under sedation or anaesthetic. You may need to go to hospital for some of these tests. Ask your doctor for more information.

How is rectal bleeding treated?

Your treatment will depend on what is causing the bleeding. Some conditions improve with simple self-care, while others may need medicines or procedures. Your doctor can help identify what is causing the bleeding and guide you on the safest treatment.

Self-care at home

Many mild causes of rectal bleeding, such as haemorrhoids or anal fissures, can be managed with lifestyle changes.

Haemorrhoids often settle down quickly after a few days. They often do not need any special treatment.

Haemorrhoids are common in pregnancy. They are often caused by constipation. Try to avoid getting constipated. Read more on prevention and treatment of constipation during pregnancy.

If your doctor tells you that you have an anal fissure, you can feel more comfortable by using these self-care methods:

• Be careful when wiping your anal area after going to the toilet. Use soft, moist toilet paper or baby wipes. Do not use dry toilet paper.
• Pat the area around your bottom, instead of rubbing it.
• Drink plenty of fluids to keep your stool (poo) as soft and well-formed as possible.
• Make sure you eat a healthy diet with plenty of fibre.
• Try not to strain when passing a stool (doing a poo).
• Have a warm bath to soothe the area.
• See your pharmacist for creams to reduce the pain.

These steps can also help prevent constipation, which may reduce the chance of symptoms returning.

Read more on anal care.

Medicines for rectal bleeding

If haemorrhoids are causing pain or discomfort, speak with your doctor or pharmacist.

Medicated creams, gels or suppositories (medicine you place in your anus) may help reduce swelling and soothe the area. Your doctor may also suggest fibre supplements or short-term laxatives if constipation is contributing to your symptoms.

Other treatments for rectal bleeding

If you have haemorrhoids that keep coming back, you can talk to your doctor about having surgery to treat them.

Treatment for anal fissures can involve Botox injections or surgery.

Your doctor may also check for other causes of rectal bleeding and recommend treatment based on what they find. These may include medical or surgical treatment, depending on the cause.

Can I prevent rectal bleeding?

There are some things you can do to help prevent some causes of rectal bleeding.

If you have constipation, you can help ease it by:

• drinking plenty of water
• eating fibre-rich foods — such as bran cereals, fruit, vegetables and wholegrain bread
• avoiding processed foods
• keeping active
• going to the toilet when you need to
• taking a fibre supplement or stool softener — ask your pharmacist to recommend one that's right for your situation

Do not put creams on the area unless recommended by your doctor or pharmacist. The wrong type of cream can cause more pain or injury.

All Australians aged between 45 and 74 years are eligible to do a free bowel screening test every 2 years through the National Bowel Cancer Screening Program.

Resources and support

If you are worried about rectal bleeding, see your doctor or call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

For more information, the Gastroenterological Society of Australia (GESA) has many patient resources about conditions that can cause rectal bleeding.

Languages other than English

The Australian Government Department of Health, Disability, and Ageing has resources about the National Bowel Cancer Screening Program in many community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

You may find these resources helpful:

• National Aboriginal Community Controlled Health Organisation (NACCHO)
  provides culturally safe health information and helps connect you with local Aboriginal Community Controlled Health Services (ACCHSs).
• The Australian Indigenous HealthInfoNet has culturally safe care and can help with assessment, treatment and follow-up for bowel and digestive health concerns.
• National Bowel Cancer Screening Program — Aboriginal and/or Torres Strait Islander peoples can find culturally appropriate information about bowel health, screening and early detection.